Mummy Makeover - II

Mum Makeover Part II – Interventional options

In Mummy makeover part I we discussed about some options of preventing problems & non-interventional options to get back to the pre pregnancy state.

Here in this post we shall discuss about the interventional options available and a few of the same.

For ease of understanding, let me divide them according the regions of involvement and the options.

Broadly we can divide the changes into:
1. Generalized skin changes.
2. Changes to the face
3. Changes to the breasts
4. Changes to the Abdomen
5. Changes to the hips / thighs

GENERALISED SKIN CHANGES:

Generally there aren’t too many changes that occur in the skin proper except for maybe more of dryness, cracking of the lips, and most importantly the “dreaded Stretch marks”.

Dry Skin:
As with any other reason for dryness, keeping the skin soft and supple is accomplished by using moisturizing & body lotions. Generally twice a day massages will help take care of this problem.

Cracked lips:
are problems especially during the later stages of pregnancy and early period post delivery. Same as with the skin, moisturizing with the use of lip balms and keeping yourself hydrated will go a long way in controlling this problem. Wetting the lips by saliva and biting them will only worsen the problem and also cause the lips to darken.

Stretch marks:
I wish I had a sure shot solution to this problem. If I did, I would be a millionaire in a few years. But, as I already mentioned in my previous blog on the same subject, the best way to treat stretch marks is to prevent them. But, am sure many of you are thinking that I’m the doctor here and I should be offering some solutions instead of saying it is untreatable. Well, there are a few options, but all have their limitations and none of them has a 100% success rate. This is because the stretch marks are due to breakage of the inner elastic dermal layer of the skin while the epidermis is still intact over it and all the treatments we have are external and aiming at promoting collages and scar deposition in the broken dermal layer of the skin.

The treatments work better in early stretch marks which are “pinkish or reddish” in appearance but not very promising in late established “white” stretch marks.

1. Chemical peels: there are various types of chemical peels which are basically long acting peels which promote collagen deposition in the deeper dermal layers of the skin. Some of the peels also tend to lighten the hyper pigmented areas, which are often associated in the stretch marked areas, which causes them to stand out more. By lightening the darker areas it helps camouflage the stretch marks better.

2. Dermaroller: This is an instrument, which works on the principle of “Microneedling” which basically means to puncture the skin with small micro needles so that there is no pain but the injury promotes collages synthesis in the deeper layers of the skin where the actual problem lies. This has shown decent results but it takes a long time for the results to be apparent. The procedure itself takes around 15 minutes to an hour depending the size of the affected area. The procedure is repeated every 4-6 weeks for 5/6 times..

3. LASER: Laser’s use the power of light to heat the deeper layers of the skin thereby promoting collages synthesis in the deeper layers. This works well in early stretch marks (pink stretch marks). Multiple sittings are required, at intervals of @ 4 weeks.


CHANGES TO THE FACE:

Most of the changes that occur during pregnancy like puffy face, dry skin and lips, are reversed post delivery. The most common change that stays on usually are pigmentation problems especially in the cheek area called “ Melasma”.

This is a problem that can be treated with a combination of peels, microdermabrasion and some skin lightening medication. But of course, skin protection from sun is an important part of the post treatment care.

As the hormonal status returns back to normalcy, the water retention and puffiness of the face also comes down. But gentle toning exercises help speed up the process.


CHANGES TO THE BREASTS:

The breasts and the abdomen are the commonest areas to bear the brunt of pregnancy. The most common problems following childbirth and breast feeding are, loss of breast volume, sagging breasts, stretch marked skin excess.

This is because during pregnancy the milk glands in the breast enlarge to replace fat in the breasts and post breast feeding involute to their original size. But, sadly the fat does not return to the breasts and if the skin has a lot of stretch marks, it does not shrink to the new reduced volume, causing sagging.

There are a few options when it comes to correcting these problems. If one feels comfortable with the size of her breasts when wearing a bra and is worried only about the sagging, she needs a “Breast Lift”. If she feels, the size in a bra is small, then an increase in volume is also needed, wherein a “Breast Augmentation or Breast Augmentation with Lift” is indicated.

1. Breast Lift (Mastopexy): This is a procedure designed to address the sagging glandular tissue of the breast as well as removing the excess skin. The basic procedure is the same, but many approaches like the classical “anchor incision”, “short scar vertical mastopexy” or a “circum areolar mastopexy” can be used. The gland is reshaped and suspended to the chest wall, the excess skin being tailored to the new breast mound to give it a proper shape.
Problems with a breast lift are usually a scar and the healing time. But apart from that it is a reasonably well tolerated procedure.

2. Breast Augmentation +/- Mastopexy: When the skin excess is not much, only an increase of breast volume in the form of an implant would suffice. In cases where the skin is in excess, augmentation using an implant is combined with a mastopexy. Here the augmentation is performed first and the breasts reassessed for residual sag. If present, the sag is taken care of by a mastopexy at the same sitting.


CHANGES TO THE ABDOMEN:

The abdominal changes are the most common and the most “visible” stigmata of pregnancy and childbirth.

The most common changes seen are loose flabby skin, stretch marks, fatty deposits, lower abdominal bulge and sometimes an upper abdomen bulge too.

The reasons for this have been discussed in the previous post “Mummy makeover- I”. Stretch marked skin does not contract and shrink, hence the loose flabby skin. Because of it the fat deposits stay and the loose muscles inside also contribute to the bulge.

The procedure to correct this deformity is commonly called the “Tummy Tuck” or an “Abdominoplasty”. There are two main variants to this procedure.

1.Regular Adbominoplasty: This is the classical method of correction of the problem. Skin excess is removed (the stretch marked skin below the level of the umbilicus), fat is sucked out with liposuction, the muscles are repaired and the hanging umbilicus, is repositioned to a normal position. This involves hospitalization for a day or two and a scar within the panty line, basically like an extension of the usual “Caesarean scar” but extending from one flank to the other. Simultaneously in selected cases the muscles can be tightened inside to bring the waist in also.

Usually there are drains left in after the surgery to drain out any excess secretions. These come out in 24-48 hours.

It is a common and well tolerated procedure, the main drawbacks being a long scar, though within the panyline. Getting back to routine activities takes around 3-4 days and regular normal work can be resumed within a week in normal circumstances.
Exercises can start within 2-3 weeks but abdominal exercises can be started only after 6 weeks. The patient has to wear a pressure garment (corset) for 6-8 weeks to help with swelling.

2.Mini Abdominoplasty: This is a variation of the regular abdominoplasty in the fact that skin excision is limited and there is no umbilical repositioning. But, liposuction and muscle repair are often needed. This is indicated when the skin excess is not much but there is muscle weakness. The scar is not as extensive as a regular abdominoplasty.


CHANGES TO HIPS / THIGHS:

Changes to the hips and thighs are usually related to weight gain. As mentioned in my previous posts, hips and thighs are genetically prone areas for weight gain in women. Pregnancy weight gain in this area is just an extension of the same. Post delivery exercising does help to get rid of this excess.

In case it cannot be done for whatever reason, then operative options are there in the form of a liposuction. Liposuction as mentioned in previous posts is a procedure to contour certain areas of the body by sucking out the excess fat using small 1cm cuts.


As you can see, many changes do occur during pregnancy leading to changes in the body, some temporary and some permanent. There are options to try and get the body to the way it was but maintenance is required.

As mentioned before, there are no short cuts. All the surgeries are procedures are aimed at bringing the body as near to as it was, but maintenance is required to keep it that way.

Also, as mentioned in my previous post “Mummy makeover –I”, many of these problems can be avoided by a little care during pregnancy and post child birth. So spread the word, pregnancy and childbirth doesn’t have to be so problematic for a woman.

Try and prevent these problems and if you already have them, most of them can be corrected. There is no reason for one to live with them, as there are “options available”!!!


Dr.Surindher

CosmesisIndia

BREAST CANCER AWARENESS

Hi friends... sorry for the long break in between..just been lazy I guess.

What spurred me to write my next post on the blog was an interview by RJ Malvika with Mrs.Jayshree on RadioIndigo ( fm91.9). Mrs. Jayshree is a Breast Cancer Survivor and she was talking about her whole experience with the disease and its aftermath and how she coped with it.

Nice to hear her experience and am sure it will help other women too. But I thought that some issues needed to be emphasized more from the point of view of the disease process and the options. So this being a awareness month with special emphasis on Breast Cancer, i thought i need to try and compile certain aspects of the same.

I think the first aspect to be dealt with should be the awareness issue regarding breast cancer, then comes the issue of dealing with it , then the treatment options and of course the rehabilitative aspect.

Awareness regarding breast cancer though picking up, is still not reach the extent to which it should. Many reasons behind it and one of the main reasons in our context is the taboo behind talking about anything related to sex. As the breast is a sign of femininity and female sexuality any talk about it is taken as taboo and hence women also tend to shun away from seeking knowledge about the same. Education is the only way to improve awareness. We see many women with advanced stages of breast cancer because they were shy to seek treatment or talk to anyone.

The first thing that any women should know and realise is that breast cancer is another disease and as with any other disease the earlier it is detected the easier it is to handle. The most important person in this “ early detection” sequence is the woman herself. “ Self Breast Examination” is an easy,simple, quick, painless test that any woman can do at her convinience.

Not every cancer can be found this way, but it is a critical step you can and should take for yourself.

Many a times the reason a woman does not want to do a SBE is because she feels so many things and feels confused. The more you examine your breasts, the more you will learn about them and the easier it will become for you to tell if something unusual has occurred.

Try to get in the habit of doing a breast self-examination once a month to familiarize yourself with how your breasts normally look and feel.

Examine yourself several days after your period ends, when your breasts are least likely to be swollen and tender. If you are no longer having periods, choose a day that's easy to remember, such as the first or last day of the month.

Don't panic if you think you feel a lump. Most women have some lumps or lumpy areas in their breasts all the time. Eight out of ten breast lumps that are removed are benign, non-cancerous.

What's important is that you get to know the look and feel of YOUR breasts' various quadrants. Has anything changed? Bring to the attention of your doctor any changes in your breasts that last longer than you monthly period cycle or are getting bigger with time.

Studies show that regular breast self-exams, combined with an annual exam by a doctor, improves the chances of detecting cancer early.

How to do a Self Breast Examination?

I could also write about self breast examination but will only serve to increase the already 1,630,000 pages on breast examination which you get on doing a google search. I'd like to highlight a few pages one could visit to know more about it.

1.Cancer patients Aid Association(CPAA) which has a lot of information and free download brochure

http://www.cpaaindia.org/infocentre/bookreview_breast.htm

http://www.cpaaindia.org/infocentre/SelfBreastExamination.doc

2.DOCTOR NDTV which has an article on breast examination

http://www.doctorndtv.com/topicsh/Breast%20Self-Examination.asp

3.Breast Self Exam is another good site which will talk you through it

http://www.breastselfexam.ca/

4.The Susan G. Komen Breast Cancer Foundation has a online breast self examination module which is also available in Hindi

http://www.komen.org/intradoc-cgi/idc_cgi_isapi.dll?IdcService=SS_GET_PAGE&nodeId=480

Here's hoping this can spur some if not all women to start making self breast examination a part of their routine and help create more awareness regarding the same.

My subsequent blogs are going to be dealing with some of the surgical options for breast cancer and more importantly I will be touching upon the options for breast reconstruction which is a topic many of the breast cancer patients are not aware of or do no even consider.

Dr.Surindher
www.cosmesisindia.com

Patient Speak -III ! " Breast Augmentation"

There isn't a single person in this world who can look into the mirror and go "Fantastic! I love the way I look! There isn't a thing I'd like to change".

We would all like to change one thing or another about our appearance. Say a smaller nose, bigger eyes, bigger breasts, flatter stomach and so the list goes on. However, not everyone is so troubled by their flawed appearance that they actually want to do something about it and change the way they look be it via simpler ways such as makeup and exercise or through slightly less common and more intimidating measures like cosmetic surgery.

Having undergone one such cosmetic procedure about six months ago, I guess I can say I was too troubled for comfort about a flaw I had perceived in my appearance....the size and shape of my breasts.

I have always been very conscious about my looks, I love to dress up and although one of the popular notions is that "Looks don't get you anywhere....they're superficial and not important....Beauty isn't skin-deep...blah....blah". I firmly believe that knowing she looks like a million bucks can do wonders to a woman's psyche, her confidence levels and self-esteem both in her personal as well as work life. The modern woman wants to look her best 24/7 and in today's world where everything has a price, if there's a way by which money can get you something that "god" and nature failed to gift you with, y not go ahead and get it? What's stopping anyone?

People say looks are insignificant...you're gonna get old...you are gonna loose your looks...they ain't gonna stay with you forever. But when you're young and looking good gives you a kick, if something as "insignificant" as a flaw in your appearance becomes a significant cause for your being unhappy and a safe solution is right under your nose, you would have to be of below average intelligence to ignore it.

In no way am I trying to justify letting your flawed looks bother you too much or going under the knife to change this and that, but I believe the bottom line is to live a happy life and if anything is a hindrance to that, but can be uprooted without hurting anyone, it should be done.

It was with a lot of apprehension that I went to meet Dr.Surindher for the very first time. I had never discussed my problem with anyone before and was anxious about several things such as letting someone see my flaws for real for the very first time, the pain involved in surgery, the cost of surgery, my family's reaction to this, etc.

However, Dr.Surindher was very professional and put me at ease very soon after I walked into his chamber. Before examining my breasts, he gave me an overview of the breast augmentation procedure explaining the different kinds of implants, the types of incisions, the expected results,the likely risks involved, common myths about the procedure, etc. I was fascinated by the amount of information he gave me. There was so much I hadn't known, although I had done some research myself about the procedure.I asked him a few questions about the surgery and what happens thereafter and got enlightening answers.

He then examined my breasts, made me try on some sample implants so that we could decide on the appropriate size for me. He also explained to me very clearly in what way the appearance of my breasts would change after implantation. One of the main problems with my breasts was that I had flatness on the upper side of my breasts as compared to the lower side where I was a little fuller. As a result, I've always had to wear slightly busty bra's to give me a fuller look. Dr.Surindher told me that implants would give me a good rise on the upper side of my breasts and also enhance the projection of my breasts to give me a fuller look. After a few trials, my asking some questions and stuff, we decided on a size and I was told I'd have to take up some routine tests before deciding to proceed with surgery. Dr.Surindher had also penned down details about the procedure so that I could review them and perhaps come back with more questions later.

Hence after a very satisfactory first visit, I made up my mind and decided to go ahead with the surgery. Just a few routine blood tests and I was back at the hospital where the physician declared me fit for surgery. Surprisingly, I was hardly nervous the morning I was to undergo surgery. I was thrilled actually 'coz I had never undergone surgery before and was curious about various things including anaesthesia. Once I was wheeled into the OT however, I was completely relaxed and the staff there were very cheerful and amicable and made it seem like I was there to have some fun.

Anaesthesia was hardly disturbing and when I came to after like I don't know how many hours, I was in hell. I don't know if it was just my extremely low threshold for pain or what but yes, I was hurting terribly. I was unable to move any part of my body. I was quite confused actually 'cos I had read women don't go through much pain and are up and about in like 48 hours after breast augmentation.

My breasts felt like lead and my back and arms were rendered immobile. It was sometime in the afternoon when I woke up from surgery and I knew I had to wait at least another couple of hours before I could see Dr.Surindher and ask him why I was in so much pain. I was given strong painkillers and sedatives for three days and while they did ease the pain a little, when the effects wore off after a few hours, I would get all impatient and desperate for relief once again. What bogged me down most was I was unable to leave my bed for almost four days after surgery despite Dr.Surindher constantly pushing me to get up, move my arms, take a walk, etc. I don't know if it was because this was my first surgical experience or due to my low tolerance for pain, I felt more agonized every time I was urged to move around. While I understood that constantly trying to move around would definitely ease the pain and make me more comfortable,it was simply too difficult.

I remember feeling like a school girl at one point of time when I started dreading Dr.Surindher's visits 'cause I knew he'd pull me up from bed and urge me to walk around and try moving my arms. He had begun to be more stern with me 'cause I was always refusing to leave my bed out of fear of pain. I think it was on the fourth day after surgery that I finally decided I couldn't do this alone and asked my mom to come over. She did and I don't know if it was the work of that magic wand all mothers have or what but I felt instantly better after she arrived and showed tremendous progress both physically and psychologically within 24 hours.

The next time Dr.Surindher came to visit me, he was very happy because I was up and walking around pretty effortlessly. I was immediately taken off the strong painkillers and was put on some mild tablets and antibiotics instead. On the fifth day,when I left the hospital,I hardly felt any pain,just a little tightness in my breasts. I had started wearing a supportive bra on the fourth day itself and that made me feel better.

Before I underwent surgery, Dr.Surindher had also explained to me what kind of bra's I should wear to ensure that my breasts are well supported. For a week after I was discharged, I stayed home, took some mild painkillers and antibiotics and kept myself as active as I could. By then I was pretty much able to indulge in my everyday activities and at the end of two weeks I felt well enough to travel by myself to visit Dr.Surindher again. This time, Dr.Surindher taught me how to massage my breasts regularly for the next 6 months and also gave me some creams to lighten the surgical scars under my breasts.

As for the way my breasts looked two weeks after surgery,the projection was certainly enhanced,my breasts were bigger and there was a good rise on the upper side of my breasts(not the flatness I had before) but since a pretty big implant had been fitted into me, my skin was all tented which gave my breasts more of a cone-shaped look rather than rounded fullness. However, Doctor told me that with regular massaging over the next 6 months the breasts will eventually fill up and take on a fuller look.

It has now been about 6 months since I underwent surgery and although I can't say I have been perfectly regular with my massages (twice everyday,mornings n evenings...it ain't easy :-) ), I have carefully followed Dr.Surindher's instructions and have been using the scar-lightening creams he gave me and have visited him for periodical examinations and the progress has been great. Like he said, within a couple of months after I began massaging, my breasts started losing their tented look and took on a rounder, fuller shape.The scars have become way lighter than they were before and will continue to fade over time is what I've been told.

The truth is I'm a much happier person today than I've ever been before. It has been a great relief to ditch the busty,uncomfortable bra's I used to wear before. The surgery and the entire process of healing and development had been a life-altering experience for me and the results were exhilarating. The way my body looks now has done wonders to my self-esteem and confidence levels and this has had a positive impact on both my professional and personal life.

Considering I had several apprehensions about undergoing the surgery and was in hell a lot of pain once i did, was it all worth the trouble??? Hell yeah!!

I'm sure Dr.Surindher can never really completely understand what a big difference this has made to my life. To me, this is the best decision I have ever made and if I had been able to do it sooner, I would have. I feel complete now and absolutely wonderful and one can't put a price on that!!

....................................................................................................................................

Dr.Surindher : - I would like to thank KS for this write up to help other patient's understand the procedure and be of help to other people who might be considering such an option.

The reason I asked her to write about it because this is the patient's point of view. I might write and explain a lot but, when it comes from the patient herself, then the whole experience is different.

She has been a wonderful patient and has been very patient even with my firmness at time understanding that it was for her own good. So as always, I once again take the opportunity to thank all my patients and for her article, especially KS.

Read more about breast augmentation on my blog http://cosmesisindia.blogspot.com/2007/02/mammamia.html

Mamma...mia.!!!!

Since times immemorial breasts have always held the fascination of mankind irrespective of the age. And the fact is just as true today as it was many years ago. But the only thing that has changed is the fact that women themselves also are starting to take notice of them. So let us examine and learn a few things about breast augmentation or as it is fondly called " A boob Job!"

Who undergoes a breast augmentation….?. Is it the celebrities or routine people?? What drives them to get the operation? Do they understand the risks involved and about the procedure???

For the first question the answer is no! It is not only the celebrities, but routine people, the housewife, the teacher, the software engineer, the doctor… people from all walks of life who undergo the procedure.

What drives them to get the procedure done?? Well a few have pathological problems in the chest area and hence have to go in for an augmentation. But, majority of the women undergo the procedure because either the volume was less to start off with or decreased with age and multiple pregnancies or sudden weight loss.

What drives them is the fact that breasts are a sign of femininity and these women feel that the decreased volume of the breasts affects the way they see themselves.

First of all let us understand some facts regarding breasts :
1. Breast size is variable in people and there is no fixed size which is the norm. Several deciding factors like the amount of breast tissue, heredity, how fat the person is and the fact that whether the person has been pregnant before all contribute to breast size. And of course age is a contributing factor as always

2.There is nothing like a perfect breasts.Usually perky breasts without a sag and nipples pointing forwards and a little laterally are acceptable as the norm but they vary with the size. Small perky breasts look good if the person is thin but not on a well built female. So its all about proportion.

3. 99.9% women have asymmetrical breasts the left usually being larger than the right. The nipples may be erect, flat, inverted, the areola may be large or small, with or without few hairs growing long, or the areola may be bumpy all of which are normal.

Regarding understanding the procedure and the risks involved, I’m sad to say that though most of the patients are educated women, hardly 10% of them really know about the procedure and the risks involved.

Broadly there are two categories of women undergoing the procedure. The first category or age group is the young women who are in their 20's who want to increase their bust size because they have underdeveloped breasts.

The second category or age group of patients are those in their 30's who are usually mother's who have finished with their families and now have their children off to school and have done with their responsibilities and want to get back into shape and feel they way they used to maybe 10 years and two children back. This section of patients has seen a steady increase and I'm sure we are going to see more of them. But in this group many a times they might require certain ancillary procedure along with a breast augmentation which is usually a breast lift or a areola reduction or the such.

Breast augmentation surgery was first performed in 1962 by a Texas plastic surgeon who used silicone breast implants to enhance the size of a woman’s breasts. 1997 HBO film "Breastmen" starring David Schwimmer and Chris Cooper shows a cinematic representation of the introduction of the concept of the breast implant to increase breast sizes and the early days of breast augmentation surgery and its pitfalls. Breast augmentation surgery has come a long way since then with lots of advancements in the type of implants and techniques, though the basic methods remain the same.

A common fear amongst women is the fear of cancer with implants. This is totally unfounded as per research done by various medical fraternities. Recently even in the US, the FDA has cleared the use of Silicone Gel implants. Otherwise, silicone gel implants are used widely all over Europe, South America, and Asia, though saline implants are also equally in vogue though more in North America..

Implants are commonly filled with saline or silicone gel. Both implant types have advantages and disadvantages. The saline implants are silicon bags into which saline is injected to fill it up. The advantage of this is that smaller incisions to place the implant can be used and the sizes can be increased or decreased in case of volumetric discrepancies between the right and the left breasts. But the disadvantage is that some of the saline may leak over a period of many years and the implant may have to be replaced.
The silicone gel implants are permanent as they do no deflate. But they require a larger incision size. They have a natural feel and the new highly cohesive gel implants do not leak even if they are punctured or cut. The choice of the implant is usually left to the patient.

The implant can be inserted in three ways either through the armpit or through a cut below the breast or through a cut around the nipple/areola. The approach is determined by the size of the implant and the individual patient. Recently the so called “Scar less Breast Augmentation” has been in demand also known as the “TUBA” Here a saline filled implant is inserted through the belly button and hence the scar is hidden giving it the name scar less.

The implant can either be placed in front of the muscle of the chest wall, “Sub glandular” or behind the muscle, “Sub muscular”. Placement of the breast implant under (behind) the pectoralis muscle is preferred in women with anatomically less breast tissue since the results are more aesthetic. Placement behind the muscle does not stop you from using those muscles, though body builders and weight lifters tend to prefer placement over the muscle.
Placement under the muscle allows for a more natural look and feel than placement over the muscle. Also, the incidence of capsular contracture is decreased with this placement. Placement behind the muscle allows easier breast self-examination and improved images with mammography when compared to placement in front of the muscle, all this because it is far away from the normal breast tissue.

The common problems after a breast augmentation surgery are mild pain and discomfort after the procedure. This is a little more in the sub muscular placement of the implant. Scar maybe a problem if you have an incision below the breast which will be seen in the initially but fades over a period of time. You might be required to do some regular massages for the next 6 months which your surgeon will explain after the surgery.

The most common cause of dissatisfaction amongst women undergoing the procedure worldwide has been the size of the implant with most women feeling that they should have gone in for a bigger implant. The cause for this is that initially because of the swelling the size looks more and as the swelling settles down the size feels a little smaller . But the size has to be determined by the amount of tissue she has, the incision , the type of implant.

In the end one has to realize that the final decisions are taken after a proper consultation and examination. Also the fact that, all surgeries have their associated risks and complications, which every surgeon operating on you will surely address.

This article was aimed at educating women about the procedure of breast augmentation, allay few fears and misconceptions and to help them make educated decisions regarding the same.

Dr.Surindher
www.cosmesisindia.com
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